MOMETASONE
Manner of administration:Application
Restriction (Streamlined authority code: 6246)
Indication: Corticosteroid-responsive dermatoses
Quantities & Cost
| Max qty packs | Max qty units | # of repeats | DPMQ | Max safety net | General Patient Charge |
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| Max qty packs: 4 | Max qty units: 4 | # of repeats: 5 | DPMQ: $28.84 | Max safety net: $25.00 | General Patient Charge: $25.00 |
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DPMQ: $42.96 | Max safety net: $25.00 | General Patient Charge: $39.12 | ||